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Pediatric Coding Alert

Give Yourself Leeway on Coding Fracture or Casting

You can ethically boost claims $80 to $125 by reporting treatment instead of splint/strap You won’t find a clear-cut answer to when you should report fracture care and when you should bill an E/M service and casting instead, but experts advise that one code set may make more sense than the other depending on the individual case. Take the following factors into account when making your decision to find the best fit for your claim.
Don’t stress: Payers don’t deny either code set as incorrect coding. Consider Fracture Care for Global Care When fracture care codes apply: When you’re wondering whether you should report fracture care, consider whether the case meets the following criteria:

 • You’re seeing the patient for her initial visit for the injury (fracture or dislocation).
 • The injury is recent enough that it has not already healed on its own.
 • The patient has not had surgery for this injury by another physician in a different practice. (For example, if the patient was injured while on vacation, had surgery and now is home and seeking follow-up, you cannot bill fracture care.)
 • You plan to care for this injury for the next 90 days.
 • The patient’s history should reveal whether the patient presented to the emergency department or another physician’s office for initial care and was later sent to your practice for further care of the fracture. Example: A patient presents with pain and swelling in his ankle following a basketball injury that occurred the previous day. Your pediatrician diagnoses the patient with a closed bimalleolar ankle fracture (824.4) and performs fracture care without manipulation.
Solution: You report 27808 (Closed treatment of bimalleolar ankle fracture [including Potts]; without manipulation) linked to 824.4. Opt for E/M and Casting in These Instances When you shouldn’t bill fracture care codes: The fracture care codes would not be appropriate if the following criteria apply:

 • The fracture is old.
 • There is a nonunion of the fracture.
 • The fracture has healed or mostly healed.
 • Your doctor is not going to care for this fracture for the next 90 days.
 • The physician doesn’t recommend follow-up visits.
 • The physician refers the patient for a more extensive procedure like percutaneous pinning or open treatment with or without fixation. In the above cases, you should bill the appropriate E/M service, such as 99201-99215 (Office or other outpatient visit ...), with the appropriate casting and strapping application codes (29000-29590) instead of a global fracture care code.
Remember: When you code application of casts [...]